Home

National Efforts: Medicare & PBM Reform
MIPA continues to work at the national level to address key issues affecting independent pharmacies.

• PBM Reform Act of 2025 (H.R. 4317): We strongly support the PBM Reform Act of 2025 (H.R. 4317), which aims to assure pharmacy access and choice for Medicare beneficiaries. This bill addresses crucial issues within Pharmacy Benefit Managers (PBMs), advocating for greater transparency, fairness, and improved access to independent pharmacies in the Medicare system.
  We encourage you to contact your representatives and urge them to cosponsor this important bill [here].

State Efforts: Pharmacy Benefit Managers (PBMs) & Local Advocacy
At the state level, MIPA remains focused on protecting independent pharmacies from the unfair practices of Pharmacy Benefit Managers (PBMs) that result in unjust reimbursements, clawbacks, post-sale adjustments, and hidden fees. Through legislative action and collaboration with lawmakers, we have successfully advanced reforms aimed at increasing PBM transparency and safeguarding pharmacy viability in Michigan.

Currently, we are actively working on addressing low reimbursement issues in state contracts with OptumRx and are pushing for the Department of Insurance and Financial Services (DIFS) to enforce existing legislation regarding PBMs to ensure compliance and fairness in the industry.

Successful Past Accomplishments

• Elimination of DIR Fees (2023): Through MIPA's tireless advocacy efforts, including collaboration with the National Community Pharmacists Association (NCPA) and other national partners, we helped achieve the elimination of DIR fees in Medicare Part D, effective 2023. This policy change has provided significant relief to independent pharmacies and ensured fairer reimbursement practices.
• Increased Medicaid Reimbursement: MIPA’s successful efforts to secure increased Medicaid reimbursement rates in Michigan have helped independent pharmacies receive fair compensation for the essential services they provide to Medicaid patients.
• Passage of HB 4348 in 2021: MIPA played a key role in the successful passage of HB 4348 in 2021, a landmark piece of legislation that addressed numerous PBM-related issues, including reimbursement rates, transparency, and audit fairness. This was a significant victory in protecting independent pharmacies and securing fairer practices in Michigan.
  Former Speaker of the House Jason Wentworth shared:
  “We were fortunate to have the opportunity to team up with the Michigan Independent Pharmacy Association and find success with this important legislation.” [See Press Release Here]

Audits
MIPA has successfully advocated for legislation that ensures more reasonable and transparent PBM audits. We remain committed to defending pharmacies from unreasonable audit practices and recoupment methods. Our current focus is on securing further protections for independent pharmacies during audits, ensuring fair and consistent practices.

Reimbursement
Thanks to our past advocacy efforts, MIPA has secured increased Medicaid reimbursement and the elimination of DIR fees, among other improvements in pharmacy reimbursement rates. However, we continue to fight for adequate reimbursement from all payers, with an emphasis on fair and sustainable rates. All pharmacies should be reimbursed at or above cost, with appropriate dispensing fees, and without “clawbacks.” MIPA is pushing for policies that ensure pharmacies are fairly compensated for their essential role in healthcare.